Transthoracic needle aspiration biopsy: Variables that affect risk of pneumothorax

Joseph E. Cox, Caroline Chiles, Christopher M. McManus, Suzanne L. Aquino, Robert H. Choplin

Research output: Contribution to journalArticle

243 Scopus citations


PURPOSE: To analyze the influence of multiple variables on the rate of pneumothorax and chest tube placement associated with transthoracic needle aspiration biopsy of the lung. MATERIALS AND METHODS: In 346 patients, 331 computed tomographically (CT) guided and 24 fluoroscopically guided lung biopsies were performed. Variables analyzed were lesion size, depth, and location; number of pleural passes; needle size; presence of emphysema; and training level of the person who performed the biopsy. RESULTS: Pneumothorax occurred at 144 (40.4%) of 356 biopsies, including 139 (42.0%) CT-guided and five (21%) fluoroscopically guided biopsies. Chest tube placement was needed in 25 (17.4%) of 144 cases of pneumothorax (7% of all biopsies). An increased rate of pneumothorax was correlated with smaller lesion size (P = .001) and presence of emphysema (P = .01). Patients with emphysema were three times as likely to require chest tube placement. The pneumothorax rate was 15% (16 of 105) if no aerated lung was traversed and approximately 50% if aerated lung was penetrated. Lesion location, needle size, number of pleural passes, and level of training were not correlated with pneumothorax rate. CONCLUSION: Smaller lesion size and emphysema are strongly correlated with occurrence of pneumothorax. Pneumothorax was more than three times less frequent if no aerated lung was traversed. After pneumothorax, chest tube placements were related to the presence of emphysema.

Original languageEnglish (US)
Pages (from-to)165-168
Number of pages4
Issue number1
StatePublished - Jul 1999
Externally publishedYes


  • Biopsies, complications
  • Computed tomography (CT), guidance
  • Lung, biopsy
  • Pneumothorax

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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